New Mexico Space Grant Consortium

First Name:
Last Name:
e-mail:	sample-applicant@example.com
Alternate e-mail:
Current Address:			Permanent Address:
City:			City:
State:	AK AL AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY Zip:		State:	AK AL AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY Zip:
Phone:	( ) -
Birthdate:

High School you graduated from:
Community College:	At what New Mexico Space Grant community college will you be enrolled during the period of this award? Central New Mexico Community College Dona Ana Community College Other - Please Specify San Juan Community College Santa Fe Community College Southwestern Indian Polytechnic Institute Please specify:
Major:
Next Semester Enrollment Status:	Freshman Sophomore
STEM Credit Hours:	Less than 9.0 credit hours 9.0 credit hours More than 9.0 credit hours Next academic year, how many STEM credit hours do you anticipate enrolling in?
Expected Graduation Date:

Educational History:

List the academic institutions you have attended starting with with current institution and ending with the first one you attended. Other than your current institution only list colleges or universities where you earned at least 10 credit hours. Please upload a PDF version of your transcript for each college/university (unofficial transcripts will be accepted.) If you are selected to receive this award, you will be required to submit your official academic transcript for verification. You will also be required to submit your Student Detailed Schedule at the beginning of the awarded semester. If you do not have a PDF conversion tool you can use one of these free on-line PDF converters: PDF Online - PDF Converter.

To ensure that your PDF files may be properly included in your application, please ensure that they are not protected via encryption, a password, a signed certificate, or in any other manner.

College/University	Major	Degree	Last Date Attended	GPA (4 pt scale)	Transcript
		BA BBA BS AB Bachelors MA MBA MS MSE Masters JD MD PhD Doctorate			File Upload
		BA BBA BS AB Bachelors MA MBA MS MSE Masters JD MD PhD Doctorate			File Upload
		BA BBA BS AB Bachelors MA MBA MS MSE Masters JD MD PhD Doctorate			File Upload
		BA BBA BS AB Bachelors MA MBA MS MSE Masters JD MD PhD Doctorate			File Upload
		BA BBA BS AB Bachelors MA MBA MS MSE Masters JD MD PhD Doctorate			File Upload

What is the highest degree you would like to attain in the future? Bachelors Masters Doctorate Other Please specify:

What would be your probable field of study for this degree? Choose Discipline Aeronautical/Aerospace Agricultural Anthropology Architectural Architecture Art Astronomy Astrophysics Atmospheric Science Biochemistry Bioengineering Biology Botany Chemical Chemistry Civil Climatology/Meteorology Computer Computer Science Earth Sciences Economics Education Electrical/Electronic Engineering Engineering Mechanics Engineering Science Environmental Environmental Science Geography Geology Geophysics Health Science/Nutrition History Industrial Life Sciences Materials Science/Engineering Mathematics Mechanical Medicine/Medical Research Mining/Petroleum & Natural Gas Molecular/Cell Biology Nuclear Oceanography Other Philosophy Physical Sciences Physics Planetary GeoSciences Planetary Sciences Political Science/Public Policy Psychology Social Sciences Sociology Zoology Other Please specify:

After completing your studies, where do you plan to work? Choose One Private Industry Teaching (K-12) NASA Non-NASA Federal Agency State/Local Government Nonprofit Organization Military Consulting Undecided

Name:
Title:
Institution:
Phone:
email:
email confirm:
	Once you have submitted your application we will email them instructions on how to submit an on-line letter of recommendation on your behalf. Please inform them that they will be receiving an email from notices@spacegrant.net with these instructions. The email may go to their spam/junk folder. Letters of recommendation are due by Monday, April 15, 2024.

Studies Interest
Describe the type of studies you would like to pursue at the university level and/or STEM-related work you would like to pursue. In addition, please indicate how you will work with your Community College mentor to guide you through your studies and help you identify a mentor at the university level. Identify the prospective university mentor by name, institution, department, and provide contact information. Your interaction with the university mentor will be an opportunity for you to learn about a particular program and learn about the mentor's work.
(350 words or less)

Understanding of NASA's work and mission
Identify which NASA Mission Directorate/s may align best with your current academic/vocational interests. Describe how your interests are related to a NASA project, or research program. This is the most important part of your application, make sure to elaborate on how your interests may fit with NASA's needs. Do your homework; learn about NASA's Mission Directorates and Field Centers.
(350 words or less)

Relevant experience and awards
Describe any relevant work or co-op experience, academic awards, and/or honors.
(300 words or less)

Financial Aid
List all past or present financial aid (scholarships, grants, loans, etc.)
(150 words or less)

The following information is for reporting purposes only.

Gender:	Male Female Do not wish to report
Ethnicity:	Hispanic or Latino Not Hispanic or Latino Do not wish to report
Race:	American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Do not wish to report
Person With Disability:	Yes No Do not wish to report
Veteran:	Have you served in the United States military? Yes No
First Generation:	Are you a first-generation college student? Yes No

• U.S. Citizenship
• Part-time enrollment during award period (minimum of 6 credit hours/semester)
• Must have a minimum of 9 STEM credit hours at the time of application
• Enrolled in STEM coursework
• Minimum 3.0 Cumulative GPA

• Must have a community college mentor
• Must submit a 1-page summary of their studies and interactions with mentor(s)
• Must complete and keep track of contact hours with mentor(s) (8 hrs. minimum)
• Must complete 10 hours of community service
• Must notify NMSGC if ineligible
• Provide short-video testimonial if requested by NMSGC office

Obligation to the Government:

Students receiving support and aid under a NASA training grant do not incur any formal obligation to the Government of the United States. However, one objective of this program will be served if the students who participate in this program continue to direct their careers toward science and engineering so that they become part of the pool from which NASA draws its workforce in the future.

Certifications:

I am a citizen of the United States of America

If awarded, I agree to release my contact information to the NMSGC Alumni Association and to allow them to contact me.

If awarded, I agree to annually update the NMSGC program office of my progress from award through first employment.

The above statements are true and correct and I give my consent to allow the information provided to be reviewed by the awards panel. I also give my consent to have all information given verified and released to NASA. If awarded, I will notify the New Mexico Space Grant Consortium if I fail to maintain eligibility during the semester(s) in which I am an award recipient. I will maintain annual contact with the New Mexico Space Grant Consortium from award to initial employment.